Tell Me Today! Let Us Talk!
Are you Turning 65?
Are you in your Golden Years (over 65)?
Are you on Medicare?
Are your final/funeral expenses covered?
Are the mortgage payments on your house covered in case of death or sickness?
Are you Under 65?

I am an independent insurance agent who can help you with your health or life insurance needs.
I can guide you to protect what matters the most.  

My service to you is at no cost and there is no condition or obligation attached.
Sign in to Google to save your progress. Learn more
Email *
Ana V Magalhaes / Licensed Insurance Agent
I am a phone call or a text away - #508 659 4340 / #760 713 6242
You can email me -
You can visit my WO (Web Office) -

Your Name *
Your Phone Number *
Best Time to Contact You Back *
Type of Insurance you want to talk about *
Date of Birth *
Gender *
Where is your City and State of permanent residence *
Medical Conditions you have *
Medications Prescribed by Doctor *
Let me Know of Any Question or Comment You have
By submitting this form, you agree to consent that I, a licensed insurance agent, contact you by email, phone call, text/SMS message at the phone number & email you provide. We do not represent all the plans in your area. For more options contact Medicare. We will not share your information with any other. Magalhaes Insurance Agency is not affiliated with any government or state agency, and it is a sole independent insurance agency. 

A copy of your responses will be emailed to the address you provided.
Clear form
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy